Dyspnea, leg effort (Borg 0 to 10 scale), ventilation, and heart rate (emax/ecap; HRmax/HRcap expressed as a percentage of capacity) were measured at maximal exercise (cycle ergometer) in 97 patients with chronic airflow limitation (CAL) (FEV1 46.6 ± 14.23% of predicted) and compared with 320 matched control subjects. Patients with CAL achieved a maximum power output of 86 ± 39.5 W (60 ± 23.2% of predicted) compared with 140 ± 37.5 W (98 ± 14.5% of predicted) in controls (p < 0.0001), emax/ecap was 72 ± 19.3% compared with 53 ± 18.6% (p < 0.0001), and HRmax/HRcap was 76 ± 13.5% compared with 82 ± 13% (p < 0.001). These findings were expected. The median intensity of dyspnea was 6 (severe to very severe) and leg effort was 7 (very severe) in both groups, and these findings were unexpected. The patients with CAL were handicapped by an increase in both dyspnea and peripheral muscular effort relative to the actual power output. The rating of dyspnea exceeded leg effort in 25 (26%) of CAL versus 69 (22%) contr...

Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation.

Dry immersion (DI) is one of the most widely used ground models of microgravity. DI accurately and rapidly reproduces most of physiological effects of short-term space flights. The model simulates such factors of space flight as lack of support, mechanical and axial unloading as well as physical inactivity. The current manuscript gathers the results of physiological studies performed from the time of the model’s development. This review describes the changes induced by DI of different duration (from few hours to 56 days) in the neuromuscular, sensory-motor, cardiorespiratory, digestive and excretory, and immune systems, as well as in the metabolism and hemodynamics. DI reproduces practically the full spectrum of changes in the body systems during the exposure to microgravity. The numerous publications from Russian researchers, which until present were mostly inaccessible for scientists from other countries are summarized in this work. These data demonstrated and validated DI as a ground-based model for simulation of physiological effects of weightlessness. The magnitude and rate of physiological changes during DI makes this method advantageous as compared with other ground-based microgravity models. The actual and potential uses of the model are discussed in the context of fundamental studies and applications for Earth medicine.

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Dry Immersion as a Ground-Based Model of Microgravity Physiological Effects

Since previous studies from this laboratory have demonstrated that the redistribution of blood volume and concomitant relative central hypervolemia induced by water immersion to the neck causes a profound natriuresis and a suppression of the renin-aldosterone system, it was of interest to assess whether the diuresis induced by immersion was mediated by an analogous inhibition of ADH. The effects of water immersion on renal water handling and urinary ADH excretion were assessed in 10 normal male subjects studied following 14 h of overnight dehydration on two occasions, control and immersion. The conditions of seated posture and time of day were identical. During control ADH persisted at or above prestudy values. Immersion resulted in a progressive decrease in ADH excretion from 80.1 plus or minus 7 (SEM) to 37.3 plus or minus 6.3 muU/min (P smaller than 0.025). Cessation of immersion was associated with a marked increase in ADH from 37.3 +/- 6.3 muU/min to 176.6 +/- 72.6 muU/min during the recovery hour (P smaller than 0.05). Concomitant with these changes urine osmolality decreased significantly beginning as early as the initial hour of immersion from 1044 +/- 36 to 542 +/- 66 mosmol/kg H2O during the final hour of immersion (P smaller than 0.001). Recovery was associated with a significant mean increase in Uosm of 190 +/- 40 mosmol/kg H2O over the final hour of immersion (P smaller than 0.001). The suppression of ADH occurred without concomitant changes in plasma tonicity. These studies are consistent with the suggestion that in hydrated subjects undergoing immersion suppression of ADH release contributes to the enhanced free water clearance, which has been previously documented.

Suppression of ADH during water immersion in normal man. [antidiuretic hormone]

This study investigated fluid and electrolyte balance in well-trained male and female swimmers during 2 training sessions. Participants were 17 nationally ranked swimmers measured during a period of intensive training. Sweat loss was assessed from changes in body mass after correction for fluid intake and urine collection. Sweat composition was measured from waterproof absorbent patches applied at 4 skin sites. Air and pool-water temperatures were 36 degrees C and 27.4 degrees C, respectively. Training lasted 105 min in each session. All measured variables were similar on the 2 testing days. Mean sweat-volume loss was 548 +/- 243 ml, and mean sweat rate was 0.31 +/- 0.1 L/hr. Mean fluid intake was 489 +/- 270 ml. Mean body-mass loss was 0.10 0.50 kg, equivalent to 0.1% +/- 0.7% dehydration. Mean pretraining urine osmolality was 662 +/- 222 mOsm/kg, which was negatively associated with both mean drink volume consumed (p = .044, r = .244) and mean urine volume produced during training (p = .002, r2 = .468). Mean sweat Na+, K+, and Cl- concentrations (mmol/L) were 43 +/- 14, 4 +/- 1, and 31 +/- 9, respectively; values were not different between males and females and were not different between days except for a marginal difference in K+ concentration. The average swimmer remained hydrated during the session, and calculated sweat rates were similar to those in previous aquatic studies.

Water and Salt Balance of Well-Trained Swimmers in Training

Determination of early cardiovascular responses to simulated gravity levels between 0 and 1 G will add knowledge of cardiovascular responses to space flight. Cardiovascular responses to 6 hours in a -5 degrees head-down bedrest model of weightlessness (0 G) were compared to those in head-up tilts of +10 degrees, +20 degrees, and +42 degrees (1/6, 1/3, and 2/3 G, respectively). Six healthy young adult males experienced the four angles on separate days. Impedance cardiography was used to measure thoracic fluid index, cardiac output, stroke volume, and peak flow. Although much intersubject variation occurred, the mean thoracic fluid content at -5 degrees decreased during the first hour and remained decreased; 6-hour values were similar to +10 degrees and +20 degrees. Heart rate decreased the first 2 hours for all angles, then increased, converging at 3-4 hours, and reached control by hour 6. Stroke volume decreased for the first 3 hours at -5 degrees, +10 degrees, +20 degrees; values at all four angles converged at hour 3 and increased in unison thereafter. Cardiac output and peak aortic flow reflected the angle at start of tilt; values at all angles converged by the second hour, decreased through the third hour, and increased thereafter. Pulse pressure decreased for the first 3 hours for angles -5 degrees, +10 degrees, and +20 degrees, converged at the fourth hour, and returned to control. Peak flow at +42 degrees was constant for the first 3 hours and increased thereafter. Blood pressure decreased for the first 2 hours, although the greatest decrease occurred at -5 degrees and +42 degrees; thereafter, values at all angles increased in unison and converged at the fourth hour. Total peripheral resistance increased during the first hour at -5 degrees and +20 degrees and decreased from hour 3 to hours 5-6 at the +42 degrees angle. Cardiovascular values were related to tilt angle for the first 2 hours of tilt, but after hour 3 values at all four angles began to converge, suggesting that cardiovascular homeostatic mechanisms seek a common adapted state regardless of effective gravity level (tilt angle) up to 2/3 G.

Acute and intermediate cardiovascular responses to zero gravity and to fractional gravity levels induced by head-down or head-up tilt.

Water immersion and prolonged bed rest reproduce nearly all the physiological responses observed in astronauts in the weightless state. Related to actual weightlessness, given responses tend to occur sooner in immersion and later in bed rest. Much research was conducted on humans using these two techniques, especially by Russian scientists. Abstracts and annotations of reports that appeared in the literature from January 1974 through December 1980 are compiled and discussed.

Physiological responses to prolonged bed rest and fluid immersion in man: A compendium of research (1974 - 1980)

Ketamine use for rapid sequence intubation (RSI) is frequent in pre‐hospital and retrieval medicine (PHARM) and is associated with potentially deleterious haemodynamic changes, which may be ameliorated by concurrent use of fentanyl.

J. Bliss

Papers

Physiological responses to prolonged bed rest and fluid immersion in man: A compendium of research (1974 - 1980)

The effect of ketamine and fentanyl on haemodynamics during intubation in pre‐hospital and retrieval medicine